Prevention of sepsis prior to prostate biopsy
Liam Toner1, Damien M Bolton1, Nathan Lawrentschuk2
1Department of Surgery, Urology Unit, University of Melbourne, Melbourne, Australia.
Purpose:
Urosepsis is the most feared complication of transrectal prostate biopsy. The incidence may be increasing from <1% to 2%-3% in contemporary series. Historically, fluoroquinolones have been effective antibiotic prophylaxis to prevent infective complications but antibiotic resistance is increasing. The increase in antibiotic resistance may contribute to reported increases in urosepsis and hospitalization after transrectal biopsy. This article will review other methods clinicians may employ to reduce the incidence of infective complications after prostate biopsy.
Materials And Methods:
A systematic review of the literature was conducted using literature databases PubMed and Ovid MEDLINE in August 2015 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) criteria.
Results:
Effective strategies to reduce infective complications after transrectal prostate biopsy include augmented prophylaxis with other antibiotics, rectal swab culture directed antibiotic prophylaxis or a transperineal biopsy approach. Needle disinfection, minimizing the number of biopsy needles and rectal disinfectants may also be of use. These methods may be of particular utility in patients with risk factors for developing urosepsis such as recent antibiotic use and overseas travel.
Conclusions:
The scientific literature describes various techniques designed to reduce infective complications caused by prostate biopsy. Clinicians should consider incorporating these novel techniques into their contemporary practice.
Insights
To reduce the risk of urosepsis after prostate biopsy, clinicians can use augmented antibiotic prophylaxis, culture-directed prophylaxis, or transperineal biopsy. These methods help prevent infection complications.
Area of Science:
- Urology
- Infectious Disease
Background:
- Urosepsis is a serious complication of transrectal prostate biopsy, with incidence potentially rising.
- Increasing antibiotic resistance to fluoroquinolones may contribute to higher rates of infection and hospitalization.
Purpose of the Study:
- To review methods for reducing infective complications after prostate biopsy.
- To address the rising incidence of urosepsis and antibiotic resistance.
Main Methods:
- Systematic literature review using PubMed and Ovid MEDLINE.
- Conducted in accordance with PRISMA criteria.
Main Results:
- Effective strategies include augmented antibiotic prophylaxis, rectal swab culture-directed prophylaxis, and transperineal biopsy.
- Additional measures: needle disinfection, minimizing needles, rectal disinfectants.
- These methods are particularly useful for high-risk patients (e.g., recent antibiotic use, travel).
Conclusions:
- The literature offers various techniques to minimize prostate biopsy-related infections.
- Clinicians should integrate these novel strategies into current practice.
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